| NPI | 1174694400 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: IN 01053733A) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: WA 0026178) |
| 207Q00000X Family Medicine (Licence: OH 71262) | |
| Enumeration Date | 2006-11-10 |
| Last Update Date | 2007-09-11 |