| NPI | 1487917811 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: AR E-8375) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: ME MD21914) |
| Enumeration Date | 2012-06-20 |
| Last Update Date | 2022-01-13 |