| NPI | 1124101969 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207QA0505X Family Medicine, Adult Medicine (Licence: IN 01055793A) |
| Additional Taxonomies | 2083A0100X Preventive Medicine, Aerospace Medicine (Licence: IN 01055793A) |
| Enumeration Date | 2006-10-23 |
| Last Update Date | 2007-07-08 |