| NPI | 1679680052 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: KY 18927) |
| Additional Taxonomies | 174400000X Specialist (Licence: KY 174400000X) |
| 207V00000X Obstetrics & Gynecology (Licence: KY 18927) | |
| Enumeration Date | 2006-08-23 |
| Last Update Date | 2020-05-05 |