| NPI | 1205891215 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: AZ 54351) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: MD D0079328) |
| 207Q00000X Family Medicine (Licence: IN 01057710A) | |
| 207Q00000X Family Medicine (Licence: KY 40270) | |
| Enumeration Date | 2006-04-20 |
| Last Update Date | 2020-09-15 |