| NPI | 1124117015 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: VA 0101252825) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: IN 01059898A) |
| Enumeration Date | 2006-10-11 |
| Last Update Date | 2023-11-27 |