| NPI | 1114989621 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: IN 01027833A) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: WI 44058) |
| Enumeration Date | 2006-04-03 |
| Last Update Date | 2014-08-04 |