| NPI | 1285603621 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: CA 53653) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: IN 01032101A) |
| 207Q00000X Family Medicine (Licence: CA C53653) | |
| Enumeration Date | 2006-03-17 |
| Last Update Date | 2018-04-02 |