| NPI | 1598746331 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: TX M2460) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: IN 01051979A) |
| Enumeration Date | 2005-11-09 |
| Last Update Date | 2019-05-14 |