| NPI | 1285825836 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: MO 2020030965) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: VA 0101244723) |
| 207Q00000X Family Medicine (Licence: TN 44017) | |
| Enumeration Date | 2007-08-08 |
| Last Update Date | 2025-05-27 |