| NPI | 1790771210 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: OR DO223379) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: IN 020030164A) |
| Enumeration Date | 2005-09-20 |
| Last Update Date | 2026-01-25 |