| 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 |