| NPI | 1750511929 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: KY 43598) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: KY R1880) |
| Enumeration Date | 2009-07-21 |
| Last Update Date | 2021-03-30 |