| NPI | 1306944228 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: DE C10001554) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: IN 01077156A) |
| Enumeration Date | 2006-09-21 |
| Last Update Date | 2021-05-07 |