| NPI | 1801246129 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: AR E-12211) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: MO 2016020179) |
| Enumeration Date | 2016-06-17 |
| Last Update Date | 2019-07-03 |