| NPI | 1568042885 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: HI MD-24299) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: MT MED-PHYS-LIC-160504) |
| Enumeration Date | 2021-04-11 |
| Last Update Date | 2026-01-21 |