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 |