| NPI | 1659802924 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: KY R4580) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: KY TP461) |
| Enumeration Date | 2017-03-27 |
| Last Update Date | 2020-12-17 |