| NPI | 1225730120 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: TN 6477) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: SC LL89941) |
| Enumeration Date | 2023-03-22 |
| Last Update Date | 2026-06-23 |