| NPI | 1861431983 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: MO 2023008369) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: TN 48055) |
| Enumeration Date | 2006-06-05 |
| Last Update Date | 2025-12-04 |