| NPI | 1689703829 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: NC 200800475) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: KY 48518) |
| Enumeration Date | 2007-03-05 |
| Last Update Date | 2021-01-13 |