| NPI | 1558364935 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: IN 01072093A) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: MI 4301063022) |
| Enumeration Date | 2005-05-31 |
| Last Update Date | 2023-04-05 |