| NPI | 1912298084 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: MI 4301114042) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: IN 11018065A) |
| Enumeration Date | 2011-04-25 |
| Last Update Date | 2019-01-02 |