| NPI | 1982963740 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: IN 01076087A) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: KY 48319) |
| Enumeration Date | 2012-05-14 |
| Last Update Date | 2018-10-17 |