| NPI | 1528297793 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: MN 65227) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: IN 01070788A) |
| Enumeration Date | 2009-07-09 |
| Last Update Date | 2019-05-22 |