| NPI | 1639377963 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: KY 50191) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: MA 244111) |
| 207Q00000X Family Medicine (Licence: SC 38679) | |
| Enumeration Date | 2007-07-09 |
| Last Update Date | 2017-12-26 |