| NPI | 1326429689 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: WA MD60845657) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: IN 01078735A) |
| Enumeration Date | 2015-06-12 |
| Last Update Date | 2020-04-09 |