| NPI | 1083680805 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: IN 02006204A) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: PA OS012432) |
| 207Q00000X Family Medicine (Licence: AZ 006906) | |
| Enumeration Date | 2006-02-23 |
| Last Update Date | 2020-11-24 |