| NPI | 1710961172 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: AK 4902) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: KY 34237) |
| 207P00000X Emergency Medicine (Licence: KY 34237) | |
| Enumeration Date | 2005-11-30 |
| Last Update Date | 2015-03-11 |