| NPI | 1053556332 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: AR E-9975) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: HI MD 11431) |
| Enumeration Date | 2008-12-15 |
| Last Update Date | 2020-03-09 |