| NPI | 1902336548 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: IA MD-47447) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: IA R-10955) |
| Enumeration Date | 2017-06-15 |
| Last Update Date | 2020-11-10 |