| NPI | 1104486885 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: TN 5357) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: VA 0116033760) |
| Enumeration Date | 2019-06-16 |
| Last Update Date | 2024-07-29 |