| NPI | 1750382040 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: IN 02004902A) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: MO 2002006268) |
| Enumeration Date | 2005-08-09 |
| Last Update Date | 2020-12-02 |