| NPI | 1104002765 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: IN 01076767A) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: VA 0101247085) |
| 207Q00000X Family Medicine (Licence: MI 4301089509) | |
| Enumeration Date | 2008-01-14 |
| Last Update Date | 2022-12-01 |