| NPI | 1710205992 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: KY 03507) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: KY R2472) |
| Enumeration Date | 2010-05-12 |
| Last Update Date | 2019-07-12 |