| NPI | 1881653053 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: PA OS014502) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: IN 02003013A) |
| Enumeration Date | 2006-03-17 |
| Last Update Date | 2020-04-22 |