| NPI | 1831650779 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: TN 67919) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: KY TP451) |
| 207P00000X Emergency Medicine (Licence: KY TP451) | |
| Enumeration Date | 2019-03-25 |
| Last Update Date | 2025-10-27 |