| NPI | 1619602265 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: IN 01096928A) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: PA MT225665) |
| Enumeration Date | 2022-07-19 |
| Last Update Date | 2025-06-20 |