| NPI | 1952415788 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: KY 02598) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: IN 02005323A) |
| Enumeration Date | 2006-08-18 |
| Last Update Date | 2022-11-04 |