| NPI | 1225568538 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: ME MD22880) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: ME EC171070) |
| Enumeration Date | 2017-06-19 |
| Last Update Date | 2023-07-03 |