| NPI | 1669456547 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: SC 88231) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: IN 01059190a) |
| Enumeration Date | 2005-12-02 |
| Last Update Date | 2023-03-13 |