| NPI | 1790881605 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207QA0505X Family Medicine, Adult Medicine (Licence: IN 01061519A) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: CA A94806) |
| Enumeration Date | 2006-09-16 |
| Last Update Date | 2011-02-23 |