| NPI | 1548781172 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: NH 20173) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: NH RT-3153) |
| Enumeration Date | 2017-07-05 |
| Last Update Date | 2020-07-29 |