| 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 |