| NPI | 1639377278 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: MN 50332) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: IN 01063601A) |
| Enumeration Date | 2007-07-05 |
| Last Update Date | 2011-08-11 |