NPI | 1295318152 |
---|---|
Former Name | JUSTIN LALTHAWM PUIA |
Entity Type | Individual |
Gender | Male |
Sole Proprietor ? | No |
Primary Taxonomy | 207Q00000X Family Medicine (Licence: OK 7760) |
Additional Taxonomies | 207Q00000X Family Medicine (Licence: TX V6390) |
Enumeration Date | 2021-04-29 |
Last Update Date | 2025-07-22 |