| NPI | 1871975490 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: ND 15946) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: IN 11018173A) |
| 207Q00000X Family Medicine (Licence: IN 01080336A) | |
| Enumeration Date | 2015-06-19 |
| Last Update Date | 2025-06-06 |