| NPI | 1326655630 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: MI 4351047308) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: IN 01092582A) |
| Enumeration Date | 2020-09-30 |
| Last Update Date | 2024-05-09 |