| NPI | 1710929377 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: KY 28936) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: IN 01039459) |
| Enumeration Date | 2006-06-11 |
| Last Update Date | 2016-08-31 |