| NPI | 1902036296 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: KY 03278) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: IN 02003755A) |
| Enumeration Date | 2009-07-21 |
| Last Update Date | 2023-12-26 |