| NPI | 1376286625 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: IA R-12373) |
| Additional Taxonomies | 207QG0300X Family Medicine, Geriatric Medicine (Licence: IN 01096551A) |
| Enumeration Date | 2022-04-14 |
| Last Update Date | 2025-07-02 |