| NPI | 1528379930 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: MD D0085034) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: KY 45908) |
| Enumeration Date | 2010-06-30 |
| Last Update Date | 2022-01-26 |