| NPI | 1760917454 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: ID M-14422) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: ID MRM-1627) |
| Enumeration Date | 2017-05-01 |
| Last Update Date | 2023-12-15 |