| NPI | 1114121696 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: AL 32728) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: IN 01066522A) |
| Enumeration Date | 2007-06-11 |
| Last Update Date | 2016-10-12 |