| NPI | 1518408921 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: VT 042.0014693) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: TN 58616) |
| Enumeration Date | 2017-03-17 |
| Last Update Date | 2023-11-07 |