| NPI | 1669121281 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: TN 6151) |
| Additional Taxonomies | 207R00000X Internal Medicine (Licence: TN 6151) |
| Enumeration Date | 2022-03-21 |
| Last Update Date | 2025-11-17 |