| NPI | 1083111512 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: CO DR.0072649) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: IN 207Q00000X) |
| Enumeration Date | 2018-04-11 |
| Last Update Date | 2024-06-24 |