| NPI | 1245497510 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: WI 54937) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: IN 01069598A) |
| Enumeration Date | 2008-05-22 |
| Last Update Date | 2023-10-11 |