| NPI | 1043456023 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: AR E-7705) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: IA R8504) |
| Enumeration Date | 2008-12-23 |
| Last Update Date | 2020-09-09 |