| NPI | 1972713428 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: IN 01063604P) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: KY 44821) |
| Enumeration Date | 2007-05-23 |
| Last Update Date | 2015-09-02 |