| NPI | 1093342685 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: HI DOSR-563) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: GU DO-0137) |
| Enumeration Date | 2020-03-24 |
| Last Update Date | 2025-08-07 |