| NPI | 1265616775 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: IN 02003437A) |
| Additional Taxonomies | 171000000X Military Health Care Provider (Licence: IN 02003437A) |
| Enumeration Date | 2007-12-19 |
| Last Update Date | 2019-07-02 |