| NPI | 1073505020 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: WA OP60098040) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: IN 02002911A) |
| Enumeration Date | 2005-08-16 |
| Last Update Date | 2021-04-05 |