| NPI | 1710364179 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207R00000X Internal Medicine (Licence: IN 01082372A) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: IN 01082372A) |
| Enumeration Date | 2015-05-05 |
| Last Update Date | 2020-12-08 |