| NPI | 1770814014 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: MO 2010020378) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: IN 01067718A) |
| Enumeration Date | 2010-01-27 |
| Last Update Date | 2018-11-21 |