| NPI | 1285868588 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: MI 5101024423) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: IN 02003818A) |
| Enumeration Date | 2009-05-14 |
| Last Update Date | 2019-08-27 |