| NPI | 1528005196 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: FL OS11876) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: IN 02001974) |
| Enumeration Date | 2006-06-01 |
| Last Update Date | 2017-03-24 |