| NPI | 1871023556 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: IN 01083177A) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: KY 57712) |
| Enumeration Date | 2017-06-15 |
| Last Update Date | 2023-04-19 |