| NPI | 1679816078 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: UT 10975428-1205) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: IN 11017415A) |
| 207Q00000X Family Medicine (Licence: IN 01074283a) | |
| Enumeration Date | 2013-04-03 |
| Last Update Date | 2019-08-19 |