| NPI | 1902210560 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: IN 11017640A) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: ID M-14656) |
| 207Q00000X Family Medicine (Licence: NM MD2017-0499) | |
| Enumeration Date | 2014-06-11 |
| Last Update Date | 2023-11-09 |