| NPI | 1689952772 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: KY 26236) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: IN 01070385A) |
| 207Q00000X Family Medicine (Licence: TN 037919) | |
| 207R00000X Internal Medicine (Licence: IN 01070385A) | |
| Enumeration Date | 2011-07-25 |
| Last Update Date | 2021-03-05 |