| NPI | 1770781288 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: MT MED-PHYS-LIC-12374) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: ID MR-0929) |
| Enumeration Date | 2007-07-05 |
| Last Update Date | 2025-04-09 |