| NPI | 1780104075 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: IN 01083727A) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: TX BP10060855) |
| Enumeration Date | 2017-06-27 |
| Last Update Date | 2020-06-24 |