| NPI | 1215340781 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: TX U8632) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: IN 01081892A) |
| 207Q00000X Family Medicine (Licence: SC 36970) | |
| Enumeration Date | 2014-06-03 |
| Last Update Date | 2024-07-24 |