| NPI | 1811525017 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: TN 4561) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: AR E-16443) |
| Enumeration Date | 2020-04-01 |
| Last Update Date | 2023-06-21 |