| NPI | 1043832058 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: ME MD27339) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: NE 35702) |
| Enumeration Date | 2020-05-13 |
| Last Update Date | 2024-09-19 |