| NPI | 1750434577 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: UT 98604271205) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: IN 01063900A) |
| Enumeration Date | 2007-01-18 |
| Last Update Date | 2022-07-21 |