| NPI | 1700520699 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: NH 39268) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: SC -) |
| Enumeration Date | 2022-04-26 |
| Last Update Date | 2026-07-07 |