| NPI | 1861888927 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: VA 0102205258) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: TN 4022) |
| Enumeration Date | 2015-04-15 |
| Last Update Date | 2026-01-06 |