| NPI | 1154173060 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: OR PG225197) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: OR PG220055) |
| Enumeration Date | 2024-04-03 |
| Last Update Date | 2025-08-05 |