| NPI | 1245205293 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 202K00000X (Licence: IN 01060951A) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: IN 01060951) |
| Enumeration Date | 2006-02-22 |
| Last Update Date | 2015-01-13 |