| NPI | 1952821126 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: MI 4301500357) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: NH RT-3150) |
| Enumeration Date | 2017-06-20 |
| Last Update Date | 2021-09-17 |