| NPI | 1659315349 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: MI 4301071005) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: IN 01058986A) |
| Enumeration Date | 2006-06-15 |
| Last Update Date | 2009-05-11 |