| NPI | 1366883316 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: IN 02006777A) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: KY 03909) |
| Enumeration Date | 2013-07-07 |
| Last Update Date | 2022-12-05 |