| NPI | 1033400379 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: MD D86578) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: NE 27142) |
| 207Q00000X Family Medicine (Licence: WV 28880) | |
| Enumeration Date | 2011-04-20 |
| Last Update Date | 2022-01-12 |