| NPI | 1720078108 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: IN 01043972A) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: SC 52696) |
| 207Q00000X Family Medicine (Licence: MI 4301116232) | |
| 207Q00000X Family Medicine (Licence: DC MD046481) | |
| 207Q00000X Family Medicine (Licence: ND 15405) | |
| 207Q00000X Family Medicine (Licence: TX R9778) | |
| Enumeration Date | 2005-10-26 |
| Last Update Date | 2019-09-11 |