| NPI | 1992732028 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: MD D0064302) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: KY 38840) |
| Enumeration Date | 2006-06-26 |
| Last Update Date | 2024-08-08 |