| NPI | 1922113752 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: FL ME134714) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: IN 01038538A) |
| Enumeration Date | 2006-08-20 |
| Last Update Date | 2024-05-13 |