| NPI | 1821295528 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: TN 51453) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: HI MD-15226) |
| Enumeration Date | 2007-06-27 |
| Last Update Date | 2021-07-19 |