| NPI | 1558392811 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: KY 15531) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: IN 01042890) |
| Enumeration Date | 2006-07-05 |
| Last Update Date | 2022-07-21 |