| NPI | 1710240221 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: MO 2015014043) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: IN 11016788A) |
| Enumeration Date | 2012-06-19 |
| Last Update Date | 2015-06-29 |