| NPI | 1750336335 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: MS 19706) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: KY 02027) |
| Enumeration Date | 2006-05-23 |
| Last Update Date | 2018-08-07 |