| NPI | 1922667765 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: IN 02006717A) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: MI 5151013948) |
| Enumeration Date | 2019-06-06 |
| Last Update Date | 2025-08-08 |