| NPI | 1336373364 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: MO 2018041655) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: IN 01070968A) |
| Enumeration Date | 2009-05-05 |
| Last Update Date | 2026-08-26 |