NPI | 1295115913 |
---|---|
Entity Type | Individual |
Gender | Male |
Sole Proprietor ? | No |
Primary Taxonomy | 207Q00000X Family Medicine (Licence: IN 01094543A) |
Additional Taxonomies | 207Q00000X Family Medicine (Licence: WV 32439) |
207Q00000X Family Medicine (Licence: IL 336107600) | |
Enumeration Date | 2015-06-08 |
Last Update Date | 2024-09-10 |