| NPI | 1932712593 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: WI 82350-20) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: NH RT-3657) |
| Enumeration Date | 2020-08-24 |
| Last Update Date | 2024-01-18 |