| NPI | 1184153140 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: MO 2020012833) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: TN 67320) |
| Enumeration Date | 2017-06-05 |
| Last Update Date | 2023-11-15 |