| NPI | 1356325302 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: MO R7G45) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: IN 01031999A) |
| Enumeration Date | 2005-12-02 |
| Last Update Date | 2008-04-22 |