| NPI | 1396717419 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: IN 01092539A) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: WI 68146) |
| 207Q00000X Family Medicine (Licence: FL ME 79400) | |
| Enumeration Date | 2006-02-02 |
| Last Update Date | 2024-06-03 |