| NPI | 1407483894 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: VA 0102207488) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: TN 4514) |
| Enumeration Date | 2020-03-25 |
| Last Update Date | 2024-01-15 |