| NPI | 1326048802 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: IN 01033506A) |
| Additional Taxonomies | 261QR1300X Clinic/Center, Rural Health (Licence: IN 200185720A) |
| Enumeration Date | 2005-07-27 |
| Last Update Date | 2015-03-10 |