| NPI | 1083766299 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: HI MD10816) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: VA 0101269763) |
| Enumeration Date | 2007-01-17 |
| Last Update Date | 2022-07-15 |