| NPI | 1073800728 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: NM MD2014-0167) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: IN 11016298A) |
| Enumeration Date | 2011-07-01 |
| Last Update Date | 2024-10-05 |