| NPI | 1316936412 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: KY 44920) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: IN 01033815A) |
| Enumeration Date | 2005-10-20 |
| Last Update Date | 2024-07-11 |