| NPI | 1700313269 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: KY 05244) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: KY TP861) |
| Enumeration Date | 2017-05-16 |
| Last Update Date | 2022-06-30 |