| NPI | 1104803212 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: IN 01042752) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: IN 01042752A) |
| Enumeration Date | 2005-12-29 |
| Last Update Date | 2022-06-03 |