| NPI | 1164443529 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: KY 34365) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: IN 01069727A) |
| Enumeration Date | 2006-07-21 |
| Last Update Date | 2019-08-19 |