| NPI | 1033197983 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: CO 0054601) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: IN 01066245A) |
| 207Q00000X Family Medicine (Licence: MN 44937) | |
| 207QA0505X Family Medicine Adult Medicine (Licence: IN 01066245A) | |
| Enumeration Date | 2006-01-01 |
| Last Update Date | 2021-03-29 |