| NPI | 1972641652 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: IN 01096250A) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: KY 41138) |
| 207Q00000X Family Medicine (Licence: FL ME146685) | |
| Enumeration Date | 2007-02-02 |
| Last Update Date | 2025-08-11 |