| NPI | 1346685674 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: UT 12777035-1205) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: IN 01076865A) |
| Enumeration Date | 2013-04-30 |
| Last Update Date | 2024-06-20 |