| NPI | 1003996281 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: MS 07415) |
| Additional Taxonomies | 261Q00000X Clinic/Center (Licence: MS 07415) |
| Enumeration Date | 2006-10-16 |
| Last Update Date | 2025-09-11 |