| NPI | 1891745733 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: IN 01065083A) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: KY KY31780) |
| Enumeration Date | 2006-05-11 |
| Last Update Date | 2022-07-27 |