| NPI | 1508386160 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: IA MD-47672) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: IN 11019612A) |
| 207Q00000X Family Medicine (Licence: WI 81192-20) | |
| Enumeration Date | 2017-06-26 |
| Last Update Date | 2023-05-02 |