| NPI | 1558458554 |
|---|---|
| Entity Type | Individual |
| Gender | N/A |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: IN 02003629A) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: MI 5101015986) |
| Enumeration Date | 2006-10-10 |
| Last Update Date | 2010-07-21 |