| NPI | 1942298088 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: IA MD-37321) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: IN 01052736A) |
| Enumeration Date | 2005-10-12 |
| Last Update Date | 2015-03-11 |