| NPI | 1801896196 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: KY 37598) |
| Additional Taxonomies | 111N00000X Chiropractor (Licence: KY 4188) |
| 207P00000X Emergency Medicine (Licence: KY 37598) | |
| Enumeration Date | 2005-07-28 |
| Last Update Date | 2019-01-17 |