| NPI | 1699938134 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: IN 02003885A) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: MO 2008018615) |
| Enumeration Date | 2008-07-03 |
| Last Update Date | 2013-01-09 |