| NPI | 1669787305 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: WI 67139) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: IN 02004193A) |
| 207Q00000X Family Medicine (Licence: VA 0102203115) | |
| Enumeration Date | 2010-08-17 |
| Last Update Date | 2020-11-16 |