| NPI | 1174510697 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: FL ME99359) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: IN 01050871A) |
| Enumeration Date | 2005-09-30 |
| Last Update Date | 2011-08-10 |