| NPI | 1043275761 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: IN 01060680A) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: CA A89493) |
| 207Q00000X Family Medicine (Licence: WI 46905-20) | |
| Enumeration Date | 2006-04-18 |
| Last Update Date | 2024-03-26 |