| NPI | 1831216985 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: WI 67784-20) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: IN 01065310A) |
| Enumeration Date | 2007-03-23 |
| Last Update Date | 2022-07-21 |