| NPI | 1851328074 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: KY 30690) |
| Additional Taxonomies | 207QA0000X Family Medicine, Adolescent Medicine (Licence: KY 30690) |
| 207QA0505X Family Medicine, Adult Medicine (Licence: KY 30690) | |
| 207QG0300X Family Medicine, Geriatric Medicine (Licence: KY 30690) | |
| 207P00000X Emergency Medicine (Licence: KY 30690) | |
| Enumeration Date | 2006-06-26 |
| Last Update Date | 2015-04-03 |