| NPI | 1386753325 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207QA0401X Family Medicine, Addiction Medicine (Licence: TN 26897) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: IN 01070077A) |
| 207Q00000X Family Medicine (Licence: NC 2025-00264) | |
| 207Q00000X Family Medicine (Licence: TN 26897) | |
| 207QA0401X Family Medicine, Addiction Medicine (Licence: IN 01070077A) | |
| Enumeration Date | 2006-08-30 |
| Last Update Date | 2025-09-03 |