| NPI | 1407029499 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: MI 4301101909) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: IN 01069057A) |
| Enumeration Date | 2008-04-10 |
| Last Update Date | 2024-05-04 |