| NPI | 1144510389 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: ND 11939) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: IN 01069427A) |
| Enumeration Date | 2011-04-08 |
| Last Update Date | 2011-08-10 |