| NPI | 1831359744 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: UT 7906638-1205) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: IN 11014440A) |
| Enumeration Date | 2008-06-13 |
| Last Update Date | 2017-06-28 |