| NPI | 1902072820 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: KY 41956) |
| Additional Taxonomies | 207RG0300X Internal Medicine, Geriatric Medicine (Licence: KY 41954) |
| Enumeration Date | 2008-04-30 |
| Last Update Date | 2021-01-26 |