| NPI | 1093165912 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207QG0300X Family Medicine, Geriatric Medicine (Licence: ID M-15278) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: IN 11019014A) |
| Enumeration Date | 2016-06-21 |
| Last Update Date | 2020-09-11 |