| NPI | 1801019880 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: IN 02003186A) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: KY 03089) |
| Enumeration Date | 2007-04-10 |
| Last Update Date | 2025-10-09 |