| NPI | 1417922667 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: AR E-2255) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: AR E2255) |
| Enumeration Date | 2006-02-21 |
| Last Update Date | 2015-09-16 |