| NPI | 1912974528 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: IN 01054627A) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: UT 7999692-1205) |
| Enumeration Date | 2006-03-02 |
| Last Update Date | 2011-10-26 |