| NPI | 1154377554 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: GA 062680) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: IN 01061776A) |
| Enumeration Date | 2006-05-26 |
| Last Update Date | 2019-09-26 |