| NPI | 1750878484 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: OR PG199359) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: MO 2017043010) |
| Enumeration Date | 2018-04-18 |
| Last Update Date | 2021-06-09 |