| NPI | 1437312709 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: WA MD60220880) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: IN 11014449) |
| Enumeration Date | 2008-07-08 |
| Last Update Date | 2022-02-11 |