| NPI | 1801116819 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: FL ME161420) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: IN 01072798A) |
| Enumeration Date | 2010-06-02 |
| Last Update Date | 2023-07-06 |