| NPI | 1194118208 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: WA OP60846293) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: IN 11018260A) |
| 207Q00000X Family Medicine (Licence: IN 02004890A) | |
| Enumeration Date | 2015-03-13 |
| Last Update Date | 2021-05-24 |