| NPI | 1801969829 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 208D00000X General Practice (Licence: CA 20A10324) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: KY R1153) |
| Enumeration Date | 2006-11-16 |
| Last Update Date | 2014-08-25 |