| NPI | 1548496185 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: TN 4097) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: KS 05-38765) |
| 207Q00000X Family Medicine (Licence: MO 2011002940) | |
| Enumeration Date | 2009-06-10 |
| Last Update Date | 2024-02-22 |