| NPI | 1669166872 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: NC 2026-01261) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: IN 11023086A) |
| Enumeration Date | 2023-06-08 |
| Last Update Date | 2026-08-04 |