| NPI | 1912133653 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: IN 01072958A) |
| Additional Taxonomies | 207R00000X Internal Medicine (Licence: OH 35.099364) |
| Enumeration Date | 2009-06-09 |
| Last Update Date | 2018-06-20 |