| NPI | 1730561143 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: KY 05642) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: AZ 007345) |
| Enumeration Date | 2015-06-22 |
| Last Update Date | 2024-02-26 |