| NPI | 1679705974 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: FL ME139409) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: IN 01071118A) |
| Enumeration Date | 2009-08-20 |
| Last Update Date | 2020-05-26 |