| NPI | 1659647717 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: IN 01084868A) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: MI 4301100567) |
| Enumeration Date | 2012-03-22 |
| Last Update Date | 2020-12-18 |