| NPI | 1811955693 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: MS 17870) |
| Additional Taxonomies | 207P00000X Emergency Medicine (Licence: MS 17870) |
| 207P00000X Emergency Medicine (Licence: AL 00024936) | |
| 207R00000X Internal Medicine (Licence: MS 17870) | |
| Enumeration Date | 2006-05-02 |
| Last Update Date | 2020-09-22 |