| NPI | 1801976402 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: SC 36168) |
| Additional Taxonomies | 207P00000X Emergency Medicine (Licence: KY R1133) |
| 2083P0901X Preventive Medicine, Public Health & General Preventive Medicine (Licence: SC 36168) | |
| Enumeration Date | 2006-10-17 |
| Last Update Date | 2024-07-15 |