| NPI | 1861926461 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: MS 28412) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: NE 1964) |
| Enumeration Date | 2017-04-20 |
| Last Update Date | 2025-12-11 |