| NPI | 1588750905 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: HI MD-11434) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: RI MD12517) |
| Enumeration Date | 2006-10-04 |
| Last Update Date | 2019-05-24 |