| NPI | 1356549588 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: IN 01067504A) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: PA MT190450) |
| Enumeration Date | 2007-07-10 |
| Last Update Date | 2011-06-06 |