| NPI | 1528627973 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: MT 116056) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: IN 11020425A) |
| Enumeration Date | 2019-06-10 |
| Last Update Date | 2023-02-08 |