| NPI | 1285857268 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: UT 7052055-1204) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: IN 11012864) |
| Enumeration Date | 2007-04-10 |
| Last Update Date | 2016-09-21 |