| NPI | 1578557278 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: NV 17482) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: IN 01052971A) |
| Enumeration Date | 2005-09-08 |
| Last Update Date | 2020-09-30 |