| NPI | 1689089666 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: UT 12503209-1204) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: IN 11017957A) |
| Enumeration Date | 2014-06-27 |
| Last Update Date | 2021-12-28 |