| NPI | 1700896057 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: IN 01083123A) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: FL ME0089854) |
| Enumeration Date | 2006-08-09 |
| Last Update Date | 2022-10-18 |