| NPI | 1972025773 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: ME MD23250) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: ME EC171048) |
| Enumeration Date | 2017-07-13 |
| Last Update Date | 2023-06-14 |