| NPI | 1336217181 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: AZ 4525) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: IN 02003021A) |
| Enumeration Date | 2006-12-01 |
| Last Update Date | 2023-04-05 |