| NPI | 1023231008 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: MI 4301093211) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: IN 11012964) |
| Enumeration Date | 2007-04-10 |
| Last Update Date | 2021-02-19 |