| NPI | 1811180409 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: KY 42142) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: KY TP164) |
| Enumeration Date | 2007-08-27 |
| Last Update Date | 2024-09-12 |