| NPI | 1013355759 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: IA MD-41892) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: NE 29544) |
| Enumeration Date | 2013-06-04 |
| Last Update Date | 2021-06-14 |