| NPI | 1518382613 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: IN 01088414A) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: PR 29323) |
| 207Q00000X Family Medicine (Licence: MI 4301106900) | |
| Enumeration Date | 2014-02-26 |
| Last Update Date | 2023-02-28 |