| NPI | 1811058860 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: KY 26077) |
| Additional Taxonomies | 207P00000X Emergency Medicine (Licence: KY 26077) |
| Enumeration Date | 2006-12-13 |
| Last Update Date | 2018-06-16 |