| NPI | 1730110206 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207R00000X Internal Medicine (Licence: KY 02797) |
| Additional Taxonomies | 261QP2300X Clinic/Center, Primary Care (Licence: KY 02797KY) |
| Enumeration Date | 2006-07-05 |
| Last Update Date | 2017-03-10 |