| NPI | 1972731214 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: NH 15614) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: KY 44996) |
| 2083P0901X Preventive Medicine, Public Health & General Preventive Medicine (Licence: NH 15614) | |
| 2083P0901X Preventive Medicine, Public Health & General Preventive Medicine (Licence: KY 44996) | |
| Enumeration Date | 2009-06-25 |
| Last Update Date | 2019-07-31 |