| NPI | 1568968360 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: CT 68624) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: CT 061526) |
| Enumeration Date | 2018-04-02 |
| Last Update Date | 2021-08-05 |