| NPI | 1174212997 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 171000000X Military Health Care Provider |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: IN 01094806A) |
| Enumeration Date | 2023-05-08 |
| Last Update Date | 2025-03-03 |