| NPI | 1013321983 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: MI 4301113611) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: IN 11017904A) |
| Enumeration Date | 2014-06-18 |
| Last Update Date | 2018-03-17 |