| NPI | 1073589859 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: NC 2023-00612) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: IN 01059935a) |
| Enumeration Date | 2006-02-23 |
| Last Update Date | 2023-09-29 |