| NPI | 1659419737 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: KY 28971) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: IN 01058291A) |
| Enumeration Date | 2007-02-02 |
| Last Update Date | 2015-12-03 |