| NPI | 1508203266 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: KY 49480) |
| Additional Taxonomies | 207R00000X Internal Medicine (Licence: KY 49480) |
| Enumeration Date | 2013-06-04 |
| Last Update Date | 2024-06-04 |