| NPI | 1871174896 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: TN PENDING) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: MS T-4850) |
| Enumeration Date | 2021-04-20 |
| Last Update Date | 2024-05-01 |