| NPI | 1962615856 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: AZ 4597) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: HI DOS-2196) |
| Enumeration Date | 2007-05-07 |
| Last Update Date | 2025-05-01 |