| NPI | 1275282162 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: TN 73433) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: WV 33007) |
| Enumeration Date | 2022-03-20 |
| Last Update Date | 2025-06-25 |