| NPI | 1598911521 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 202K00000X (Licence: FL ME122130) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: IN 01067389A) |
| Enumeration Date | 2008-08-11 |
| Last Update Date | 2019-08-20 |