| NPI | 1720421027 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: KY 04003) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: IN 02004524A) |
| Enumeration Date | 2013-04-17 |
| Last Update Date | 2023-07-13 |