| NPI | 1710298252 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: IA MD-40925) |
| Additional Taxonomies | 282N00000X General Acute Care Hospital |
| Enumeration Date | 2010-06-30 |
| Last Update Date | 2024-03-15 |