| NPI | 1740218577 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: NC 200001371) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: IN 01035166A) |
| Enumeration Date | 2006-06-29 |
| Last Update Date | 2019-08-29 |