| NPI | 1861456592 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: FL ME131235) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: IN 01055241A) |
| Enumeration Date | 2006-04-12 |
| Last Update Date | 2022-07-21 |