| NPI | 1043448657 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: KY 03494) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: IN 11015003) |
| 207Q00000X Family Medicine (Licence: SC 90116) | |
| Enumeration Date | 2009-06-23 |
| Last Update Date | 2026-02-19 |