| NPI | 1891144572 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: TN 61916) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: KY TP438) |
| 207Q00000X Family Medicine (Licence: KY 52912) | |
| Enumeration Date | 2016-06-03 |
| Last Update Date | 2021-11-28 |