| NPI | 1710327952 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: FL ME150077) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: IN 01076733A) |
| Enumeration Date | 2013-07-02 |
| Last Update Date | 2023-12-29 |