| NPI | 1952600132 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: AR E-15562) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: WI 60148) |
| Enumeration Date | 2011-03-27 |
| Last Update Date | 2024-12-11 |