| NPI | 1194701359 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: IN 01065737A) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: OR MD17476) |
| Enumeration Date | 2005-12-20 |
| Last Update Date | 2019-06-19 |