| NPI | 1568045870 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: OR MD220471) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: MS T-4324) |
| Enumeration Date | 2021-05-04 |
| Last Update Date | 2024-09-19 |