| NPI | 1083297287 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: ID M-16990) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: ID MRM-2026) |
| Enumeration Date | 2021-05-04 |
| Last Update Date | 2024-09-17 |