| NPI | 1871918607 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: KY TP666) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: HI MD-18361) |
| 208D00000X General Practice (Licence: HI MD-18361) | |
| Enumeration Date | 2014-03-04 |
| Last Update Date | 2023-07-10 |