| NPI | 1659343614 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: KY 18895) |
| Additional Taxonomies | 207QA0505X Family Medicine Adult Medicine (Licence: KY 18895) |
| Enumeration Date | 2006-02-03 |
| Last Update Date | 2015-05-27 |