| NPI | 1952512238 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: KY 03253) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: PA OS008586-L) |
| 207Q00000X Family Medicine (Licence: TN 1873) | |
| Enumeration Date | 2007-05-25 |
| Last Update Date | 2014-07-17 |