| NPI | 1184672867 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207QA0505X Family Medicine, Adult Medicine (Licence: FL ME139058) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: IN 01061744A) |
| Enumeration Date | 2006-05-04 |
| Last Update Date | 2025-10-06 |