| NPI | 1154366680 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: IN 02002151A) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: MI 5101010457) |
| Enumeration Date | 2006-06-18 |
| Last Update Date | 2013-12-31 |