| NPI | 1710640594 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: FL HSE18306) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: NJ 041902) |
| 207Q00000X Family Medicine (Licence: IN CV2102937) | |
| 207Q00000X Family Medicine (Licence: NH EL07953) | |
| Enumeration Date | 2021-10-18 |
| Last Update Date | 2021-11-18 |