| NPI | 1922090125 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: MO 2005039927) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: IN 02002722A) |
| Enumeration Date | 2005-08-16 |
| Last Update Date | 2015-05-20 |