| NPI | 1316326960 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: TN 56877) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: GA 77473) |
| 207Q00000X Family Medicine (Licence: GA 077473) | |
| Enumeration Date | 2015-05-28 |
| Last Update Date | 2025-09-22 |