| NPI | 1073598330 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: IN 01041620) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: KY 51751) |
| Enumeration Date | 2005-12-09 |
| Last Update Date | 2020-08-18 |