| NPI | 1073924239 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: ID M-13205) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: ID MRM-1399) |
| 207Q00000X Family Medicine (Licence: OR MD186098) | |
| Enumeration Date | 2014-05-09 |
| Last Update Date | 2023-08-02 |