| NPI | 1376773994 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: WY 11719A) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: IN 01071769A) |
| Enumeration Date | 2009-07-16 |
| Last Update Date | 2023-04-28 |