NPI | 1831650779 |
---|---|
Entity Type | Individual |
Gender | Male |
Sole Proprietor ? | No |
Primary Taxonomy | 207Q00000X Family Medicine (Licence: KY TP451) |
Additional Taxonomies | 207P00000X Emergency Medicine (Licence: KY TP451) |
Enumeration Date | 2019-03-25 |
Last Update Date | 2022-06-30 |