| NPI | 1750367983 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: KY 46156) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: LA 024656) |
| Enumeration Date | 2005-12-20 |
| Last Update Date | 2017-01-18 |