| NPI | 1720048093 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: KY 28181) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: IN 01067451A) |
| Enumeration Date | 2006-03-23 |
| Last Update Date | 2017-03-08 |