| NPI | 1982263323 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: SC 88582) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: IN 11020581A) |
| Enumeration Date | 2019-06-10 |
| Last Update Date | 2022-10-04 |