| NPI | 1508178336 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: KY 03609) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: IN 11015675) |
| Enumeration Date | 2010-07-09 |
| Last Update Date | 2024-04-23 |