| NPI | 1407235955 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: FL ME136218) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: IN 11018468A) |
| Enumeration Date | 2015-05-29 |
| Last Update Date | 2026-04-22 |