| NPI | 1104817790 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: NC 200301154) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: IN 02000877A) |
| Enumeration Date | 2005-11-02 |
| Last Update Date | 2018-08-17 |