| NPI | 1043417496 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: WI 83799-20) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: IN 11013989A) |
| Enumeration Date | 2007-06-29 |
| Last Update Date | 2025-09-03 |