| NPI | 1730155003 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: KY 43366) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: GA 043066) |
| Enumeration Date | 2006-02-27 |
| Last Update Date | 2023-03-01 |