| NPI | 1689657785 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: MI 4301069478) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: IN 01038410A) |
| Enumeration Date | 2005-11-22 |
| Last Update Date | 2023-08-15 |