| NPI | 1194164749 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: IN 11017325A) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: KY 03993) |
| Enumeration Date | 2013-06-17 |
| Last Update Date | 2016-08-04 |