| NPI | 1811250392 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: MT 72874) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: ID MRM-1242) |
| Enumeration Date | 2012-06-20 |
| Last Update Date | 2023-11-27 |