| NPI | 1770746794 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: KY 44694) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: MO 2011008012) |
| Enumeration Date | 2008-07-09 |
| Last Update Date | 2011-11-28 |