| NPI | 1912058272 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: KY 39587) |
| Additional Taxonomies | 207P00000X Emergency Medicine (Licence: KY 39587) |
| Enumeration Date | 2007-01-15 |
| Last Update Date | 2023-03-07 |