| NPI | 1790796654 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: KY 03576) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: IN 11012923) |
| Enumeration Date | 2006-08-10 |
| Last Update Date | 2020-12-04 |