| NPI | 1003844465 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: HI MD-18804) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: CT 043947) |
| Enumeration Date | 2006-06-28 |
| Last Update Date | 2021-05-19 |