| NPI | 1932729191 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: TN 69095) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: KY 57356) |
| Enumeration Date | 2020-04-17 |
| Last Update Date | 2024-06-25 |