| NPI | 1316930548 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: HI MD-14515) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: CT 038503) |
| Enumeration Date | 2005-08-23 |
| Last Update Date | 2023-06-28 |