| NPI | 1891975280 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: KY KY41249) |
| Additional Taxonomies | 207P00000X Emergency Medicine (Licence: KY 41249) |
| Enumeration Date | 2007-11-14 |
| Last Update Date | 2025-08-13 |