| NPI | 1801898358 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: OR MD18831) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: NH 9782) |
| Enumeration Date | 2005-08-15 |
| Last Update Date | 2023-03-07 |