| NPI | 1770149916 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: ME TP19032) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: ME TP21080) |
| Enumeration Date | 2019-05-14 |
| Last Update Date | 2022-01-25 |