| NPI | 1881008647 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: IN 01091741A) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: KY 50239) |
| Enumeration Date | 2014-06-19 |
| Last Update Date | 2025-09-09 |