| NPI | 1184079246 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: CA A198289) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: WI 71634) |
| 207Q00000X Family Medicine (Licence: TN 62396) | |
| 207Q00000X Family Medicine (Licence: MS 28340) | |
| 207Q00000X Family Medicine (Licence: AR E-14551) | |
| Enumeration Date | 2016-04-26 |
| Last Update Date | 2026-05-29 |