| NPI | 1386679496 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: NC 200901870) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: IN 01023417) |
| Enumeration Date | 2006-07-11 |
| Last Update Date | 2010-04-01 |