| NPI | 1295798791 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: KY 27287) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: IN 01058385A) |
| Enumeration Date | 2006-04-07 |
| Last Update Date | 2023-05-02 |