| NPI | 1982929949 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: NC 2015-01542) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: KY 47126) |
| Enumeration Date | 2010-04-02 |
| Last Update Date | 2024-02-12 |