| NPI | 1720158181 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: IN 02003148A) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: NV DO2463) |
| Enumeration Date | 2006-11-09 |
| Last Update Date | 2023-12-29 |