| NPI | 1811997166 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: KY 19938) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: IN 01028002A) |
| Enumeration Date | 2005-07-28 |
| Last Update Date | 2010-04-26 |