| NPI | 1063901551 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: IN 020063763A) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: NV SL13333) |
| Enumeration Date | 2018-05-09 |
| Last Update Date | 2025-10-15 |