| NPI | 1659567808 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: NH 14817) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: NH RT1785) |
| Enumeration Date | 2007-09-21 |
| Last Update Date | 2023-04-12 |