| NPI | 1730226655 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: IN 01056163A) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: MN 42463) |
| 207Q00000X Family Medicine (Licence: WI 39693-020) | |
| 207Q00000X Family Medicine (Licence: OH 35080445-T) | |
| Enumeration Date | 2007-01-31 |
| Last Update Date | 2023-03-07 |