| NPI | 1053351361 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: ID M-9850) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: IN 01060962A) |
| Enumeration Date | 2006-06-07 |
| Last Update Date | 2012-07-11 |