| NPI | 1164407326 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: IN 01081741A) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: WI 50704) |
| 207Q00000X Family Medicine (Licence: TX H0464) | |
| Enumeration Date | 2005-12-09 |
| Last Update Date | 2022-12-28 |