| NPI | 1609496686 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: MI 5101027157) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: IN 02007317A) |
| Enumeration Date | 2020-04-20 |
| Last Update Date | 2026-07-08 |