| NPI | 1457383416 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: IN 01062020A) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: KY 30925) |
| 207Q00000X Family Medicine (Licence: TN 40954) | |
| Enumeration Date | 2006-07-07 |
| Last Update Date | 2016-01-06 |