| NPI | 1689108821 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: KY 54633) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: SC 51110) |
| 207Q00000X Family Medicine (Licence: KY TP575) | |
| Enumeration Date | 2017-04-14 |
| Last Update Date | 2023-05-01 |