| 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 |