| NPI | 1740771344 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: TN 4427) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: VA 0102207525) |
| Enumeration Date | 2018-05-21 |
| Last Update Date | 2024-10-23 |