NPI | 1568410660 |
---|---|
Entity Type | Individual |
Gender | Male |
Sole Proprietor ? | No |
Primary Taxonomy | 207Q00000X Family Medicine (Licence: KY 22811) |
Additional Taxonomies | 208D00000X General Practice (Licence: KY 22811) |
Enumeration Date | 2006-05-04 |
Last Update Date | 2014-06-13 |