| NPI | 1659692234 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: KY 03802) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: IN 02005199A) |
| Enumeration Date | 2010-06-17 |
| Last Update Date | 2018-10-08 |