| NPI | 1548611049 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: FL TRN23601) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: AR E-12415) |
| Enumeration Date | 2016-06-26 |
| Last Update Date | 2019-07-19 |