| NPI | 1083001242 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: AZ 57428) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: NM MD2017-0949) |
| Enumeration Date | 2015-04-24 |
| Last Update Date | 2021-04-07 |