| NPI | 1881124378 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: VA 0116030740) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: TN 3554) |
| Enumeration Date | 2017-06-15 |
| Last Update Date | 2022-07-21 |