| NPI | 1669030904 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: TN 65514) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: FL ME147179) |
| Enumeration Date | 2019-06-02 |
| Last Update Date | 2024-01-17 |