| NPI | 1982132288 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: KY 57405) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: KY TP160) |
| 207Q00000X Family Medicine (Licence: MI 4301501968) | |
| 207Q00000X Family Medicine (Licence: MI 4301111927) | |
| 207Q00000X Family Medicine (Licence: WI 75831) | |
| Enumeration Date | 2017-05-31 |
| Last Update Date | 2022-12-21 |