| NPI | 1710151378 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: IN 01064978A) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: PA MT187098) |
| 207Q00000X Family Medicine (Licence: AZ 40518) | |
| Enumeration Date | 2008-04-15 |
| Last Update Date | 2012-02-01 |