| NPI | 1972955995 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: TN 60068) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: GA 008734) |
| Enumeration Date | 2016-07-02 |
| Last Update Date | 2025-02-14 |