| NPI | 1770680811 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: KY 39534) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: IN 01062113A) |
| Enumeration Date | 2006-09-20 |
| Last Update Date | 2022-09-23 |