| NPI | 1093898702 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: TN 47774) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: VA 0101250287) |
| 207Q00000X Family Medicine (Licence: IN 01049962) | |
| Enumeration Date | 2006-10-24 |
| Last Update Date | 2012-08-23 |