| NPI | 1366183790 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: ID 3781208) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: IN 02007373A) |
| Enumeration Date | 2022-04-07 |
| Last Update Date | 2026-06-03 |