| NPI | 1558333286 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207QA0505X Family Medicine, Adult Medicine (Licence: KY 19109) |
| Additional Taxonomies | 207P00000X Emergency Medicine (Licence: KY 19109) |
| Enumeration Date | 2006-02-06 |
| Last Update Date | 2015-04-17 |