| NPI | 1609835446 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: KS 0438173) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: IN 01057134A) |
| Enumeration Date | 2006-03-21 |
| Last Update Date | 2023-03-20 |