| NPI | 1487853115 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: IN 02006732A) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: SC LL 1073) |
| Enumeration Date | 2007-07-12 |
| Last Update Date | 2022-06-23 |