| NPI | 1902148422 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: KY 49147) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: IN 11017050A) |
| Enumeration Date | 2013-03-22 |
| Last Update Date | 2020-04-10 |