| NPI | 1528297793 | 
|---|---|
| Entity Type | Individual | 
| Gender | Male | 
| Sole Proprietor ? | No | 
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: IN 01070788A) | 
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: MN 65227) | 
| Enumeration Date | 2009-07-09 | 
| Last Update Date | 2025-01-17 |