| NPI | 1063745768 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: IN 01096271A) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: TX P0816) |
| Enumeration Date | 2009-09-12 |
| Last Update Date | 2025-08-05 |