| NPI | 1013463785 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: MS 25562) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: MS T-3257) |
| Enumeration Date | 2016-08-31 |
| Last Update Date | 2019-07-16 |