| NPI | 1821073701 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: KY 22825) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: OR MD14783) |
| Enumeration Date | 2005-12-13 |
| Last Update Date | 2017-12-22 |