NPI | 1073831749 |
---|---|
Entity Type | Individual |
Gender | Male |
Sole Proprietor ? | No |
Primary Taxonomy | 207Q00000X Family Medicine (Licence: LA 203851) |
Additional Taxonomies | 207Q00000X Family Medicine (Licence: IN 01067928A) |
207Q00000X Family Medicine (Licence: MS 24745) | |
Enumeration Date | 2010-05-05 |
Last Update Date | 2017-02-09 |