| NPI | 1255869897 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: ME MD20433) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: UT 11008066-1205) |
| Enumeration Date | 2017-05-26 |
| Last Update Date | 2020-08-28 |