| NPI | 1770854028 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: HI MD-22122) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: NH 16648) |
| Enumeration Date | 2012-01-18 |
| Last Update Date | 2022-07-27 |