| NPI | 1306032917 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: IN 02003624A) |
| Additional Taxonomies | 2083A0100X Preventive Medicine, Aerospace Medicine (Licence: VA 0102205084) |
| Enumeration Date | 2007-09-18 |
| Last Update Date | 2023-08-17 |