| NPI | 1831548510 | 
|---|---|
| Entity Type | Individual | 
| Gender | Male | 
| Sole Proprietor ? | No | 
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: IN 02005141A) | 
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: IN 11018825A) | 
| Enumeration Date | 2016-06-03 | 
| Last Update Date | 2020-12-21 |