| NPI | 1053548354 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: WA OP60190278) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: IN 02004375A) |
| Enumeration Date | 2009-06-15 |
| Last Update Date | 2023-05-02 |