NPI | 1720367642 |
---|---|
Entity Type | Individual |
Gender | Male |
Sole Proprietor ? | Yes |
Primary Taxonomy | 207Q00000X Family Medicine (Licence: KY TP133) |
Additional Taxonomies | 207QG0300X Family Medicine, Geriatric Medicine (Licence: KY TP133) |
207QH0002X Family Medicine, Hospice and Palliative Medicine (Licence: KY TP133) | |
Enumeration Date | 2011-08-09 |
Last Update Date | 2022-12-06 |