| NPI | 1811331804 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: KY R3354) |
| Additional Taxonomies | 207P00000X Emergency Medicine (Licence: KY 03890) |
| Enumeration Date | 2013-04-22 |
| Last Update Date | 2016-10-20 |