| NPI | 1851688162 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: MS T2466) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: GA 71768) |
| Enumeration Date | 2011-07-07 |
| Last Update Date | 2022-01-25 |