| NPI | 1851650790 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: FL ME142112) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: KY R3005) |
| 207P00000X Emergency Medicine (Licence: KY R3005) | |
| Enumeration Date | 2012-05-13 |
| Last Update Date | 2022-08-02 |