| NPI | 1952497810 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: ID M-6065) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: MT 90015) |
| Enumeration Date | 2006-10-05 |
| Last Update Date | 2020-12-22 |