| NPI | 1154511046 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: UT 13117393) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: ID M-10400) |
| 207Q00000X Family Medicine (Licence: IA R8235) | |
| 207Q00000X Family Medicine (Licence: IN 01081362A) | |
| Enumeration Date | 2007-07-27 |
| Last Update Date | 2025-07-10 |