| NPI | 1770859878 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: OR MD222668) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: IN 01072999A) |
| Enumeration Date | 2012-03-22 |
| Last Update Date | 2025-07-28 |