| NPI | 1770781288 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: MT 12374) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: ID MR-0929) |
| Enumeration Date | 2007-07-05 |
| Last Update Date | 2023-08-21 |