| NPI | 1972814192 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: MD H76407) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: NH RT-2118) |
| Enumeration Date | 2010-06-23 |
| Last Update Date | 2017-02-14 |