| NPI | 1033524004 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: HI MD-24650) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: HI MDR6671) |
| Enumeration Date | 2014-06-27 |
| Last Update Date | 2025-03-26 |