| NPI | 1972129765 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: TN 5253) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: GA 11980) |
| Enumeration Date | 2020-06-17 |
| Last Update Date | 2023-08-02 |