| NPI | 1073951570 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: IA MD-42566) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: NE 6942) |
| Enumeration Date | 2013-06-06 |
| Last Update Date | 2020-10-09 |