| NPI | 1639699051 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: ME MD22947) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: SC 84336) |
| Enumeration Date | 2017-06-27 |
| Last Update Date | 2024-02-08 |