| NPI | 1083639272 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: KY 36386) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: IN 01053898) |
| Enumeration Date | 2006-07-12 |
| Last Update Date | 2016-10-05 |