| NPI | 1700877362 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: FL ME115501) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: IN 01032765) |
| Enumeration Date | 2005-11-02 |
| Last Update Date | 2014-04-18 |