| NPI | 1679734693 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: KY 44622) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: KY TP001) |
| Enumeration Date | 2008-06-23 |
| Last Update Date | 2011-12-27 |