| NPI | 1063906477 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: VA 0102207020) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: IN 11020144A) |
| Enumeration Date | 2018-06-19 |
| Last Update Date | 2025-12-07 |