| NPI | 1508111691 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: OR MD217809) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: IN 01073652A) |
| 207Q00000X Family Medicine (Licence: WA MD61478042) | |
| Enumeration Date | 2012-07-16 |
| Last Update Date | 2023-10-13 |