| NPI | 1043293996 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 202K00000X (Licence: MO 2005006001) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: MO 2005006001) |
| 207Q00000X Family Medicine (Licence: IN 01060297A) | |
| Enumeration Date | 2005-11-23 |
| Last Update Date | 2018-02-28 |