| NPI | 1174935118 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: IN 0108711A) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: TX R5375) |
| 207Q00000X Family Medicine (Licence: UT 9529166-1205) | |
| Enumeration Date | 2014-05-27 |
| Last Update Date | 2018-08-30 |