| NPI | 1881075570 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: KY 04299) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: SC 52111) |
| Enumeration Date | 2015-06-18 |
| Last Update Date | 2021-06-15 |