| NPI | 1801276167 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: NH 19098) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: CT 57083) |
| Enumeration Date | 2015-06-02 |
| Last Update Date | 2018-09-14 |