| NPI | 1528551041 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: NH 21764) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: NH RT-3294) |
| Enumeration Date | 2018-06-09 |
| Last Update Date | 2021-08-10 |