| NPI | 1649207416 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: AL MD.44726) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: TN 14377) |
| 207Q00000X Family Medicine (Licence: MS 16383) | |
| Enumeration Date | 2006-06-27 |
| Last Update Date | 2025-10-14 |