| NPI | 1316966948 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207QA0505X Family Medicine, Adult Medicine (Licence: IN 01039083A) |
| Additional Taxonomies | 207QA0505X Family Medicine, Adult Medicine (Licence: MI 4301028134) |
| Enumeration Date | 2006-07-18 |
| Last Update Date | 2007-07-08 |