| NPI | 1831894039 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: OR MD231199) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: OR PG225193) |
| Enumeration Date | 2023-04-05 |
| Last Update Date | 2026-08-18 |