| NPI | 1952392508 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: WA MD60460303) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: IN 01059915A) |
| Enumeration Date | 2005-11-02 |
| Last Update Date | 2022-02-15 |