| NPI | 1740383637 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: KY 02980) |
| Additional Taxonomies | 204D00000X Neuromusculoskeletal Medicine & OMM (Licence: KY 02980) |
| 207P00000X Emergency Medicine (Licence: KY R0849) | |
| Enumeration Date | 2006-09-06 |
| Last Update Date | 2025-04-17 |