| NPI | 1700885498 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: IN 02001650A) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: MI 5101013733) |
| Enumeration Date | 2005-07-15 |
| Last Update Date | 2019-02-22 |