| NPI | 1821583253 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: ME MD24257) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: IA R-11150) |
| Enumeration Date | 2018-06-27 |
| Last Update Date | 2024-07-16 |