| NPI | 1699942987 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: UT 374582-1204) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: IN 11014185A) |
| Enumeration Date | 2008-05-15 |
| Last Update Date | 2017-07-07 |