| NPI | 1083107239 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: IN 01086286A) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: PA MT216389) |
| Enumeration Date | 2018-06-12 |
| Last Update Date | 2021-08-30 |