| NPI | 1629020078 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: IN 01061465A) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: KY 39527) |
| Enumeration Date | 2006-05-16 |
| Last Update Date | 2020-03-20 |