| NPI | 1104358670 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: MO 2021034961) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: IN 11019421A) |
| 207R00000X Internal Medicine (Licence: MO 2021034961) | |
| 207R00000X Internal Medicine (Licence: IN 11019421A) | |
| Enumeration Date | 2017-04-03 |
| Last Update Date | 2021-08-30 |