| NPI | 1790764868 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: MI 5101012140) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: IN 02001246A) |
| Enumeration Date | 2006-01-17 |
| Last Update Date | 2024-02-22 |