| NPI | 1922304138 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: KY 23832) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: IN 01065419A) |
| 207Q00000X Family Medicine (Licence: VA 0101244204) | |
| Enumeration Date | 2011-02-04 |
| Last Update Date | 2011-02-04 |