| NPI | 1770692642 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: HI MD-11551) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: FL TPME4933) |
| 207Q00000X Family Medicine (Licence: MP 0392) | |
| Enumeration Date | 2006-08-30 |
| Last Update Date | 2023-04-24 |