| NPI | 1417945171 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: SC 1189) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: IN 02002675A) |
| Enumeration Date | 2005-10-07 |
| Last Update Date | 2017-07-13 |