| NPI | 1780996918 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: FL ME147765) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: IN 01074589A) |
| 207Q00000X Family Medicine (Licence: WV 25027) | |
| Enumeration Date | 2010-07-02 |
| Last Update Date | 2026-08-03 |