| NPI | 1770570400 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: KY 36713) |
| Additional Taxonomies | 207P00000X Emergency Medicine (Licence: KY 36713) |
| 207Q00000X Family Medicine (Licence: IN 01044033A) | |
| Enumeration Date | 2005-09-27 |
| Last Update Date | 2020-04-27 |