| NPI | 1346551082 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: MI 5101018510) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: IN 11015729A) |
| Enumeration Date | 2010-06-28 |
| Last Update Date | 2023-01-31 |