| NPI | 1417950726 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: IN 02003038A) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: MI 5101012626) |
| Enumeration Date | 2005-05-31 |
| Last Update Date | 2022-06-20 |