| NPI | 1225038391 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: FL ME95364) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: IN 01052422) |
| Enumeration Date | 2005-07-29 |
| Last Update Date | 2021-11-03 |