| NPI | 1295724664 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: MA 234325) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: IN 02002065A) |
| Enumeration Date | 2005-10-18 |
| Last Update Date | 2019-06-18 |