| NPI | 1871798892 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: IN 01081722A) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: OH 35130872) |
| 207Q00000X Family Medicine (Licence: AK 5269) | |
| 207ZP0102X Pathology, Anatomic Pathology & Clinical Pathology (Licence: OH 35130872) | |
| 207ZP0102X Pathology, Anatomic Pathology & Clinical Pathology (Licence: AK 5269) | |
| Enumeration Date | 2007-06-19 |
| Last Update Date | 2019-03-22 |