| NPI | 1497724678 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: IN 02002514A) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: WI 66015) |
| Enumeration Date | 2006-03-17 |
| Last Update Date | 2021-03-15 |