| NPI | 1457555831 | 
|---|---|
| Entity Type | Individual | 
| Gender | Male | 
| Sole Proprietor ? | No | 
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: IN 01064187A)  | 
| Additional Taxonomies | 208D00000X General Practice (Licence: IN 01064187a)  | 
| Enumeration Date | 2007-06-12 | 
| Last Update Date | 2021-05-28 |