| 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 |