| NPI | 1851731582 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: MO 2016010947) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: IN 11017420A) |
| Enumeration Date | 2013-06-26 |
| Last Update Date | 2018-02-14 |