| NPI | 1457618050 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: IN 01075778A) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: CO DR0056471) |
| Enumeration Date | 2012-04-19 |
| Last Update Date | 2022-10-15 |