| NPI | 1588658272 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: KY 37824) |
| Additional Taxonomies | 207QA0505X Family Medicine, Adult Medicine (Licence: KY 37824) |
| Enumeration Date | 2005-09-08 |
| Last Update Date | 2015-06-18 |