| NPI | 1487090502 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: IN 11017413A) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: UT 9735346-1205) |
| Enumeration Date | 2013-05-15 |
| Last Update Date | 2016-07-16 |