| NPI | 1083691471 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: KY TP297) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: IN 01038628) |
| Enumeration Date | 2005-12-27 |
| Last Update Date | 2018-02-08 |