| NPI | 1316916745 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: MO 2007016904) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: IN 01052730A) |
| Enumeration Date | 2006-03-17 |
| Last Update Date | 2023-02-16 |