| NPI | 1598962151 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: IN 02003646A) |
| Additional Taxonomies | 171000000X Military Health Care Provider |
| Enumeration Date | 2007-06-28 |
| Last Update Date | 2018-03-17 |