| NPI | 1598826349 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: TN 02434) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: KY 03105) |
| 207Q00000X Family Medicine (Licence: KY R1276) | |
| Enumeration Date | 2006-12-13 |
| Last Update Date | 2024-02-06 |