| NPI | 1083021638 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: OR DO185779) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: OR PG173375) |
| Enumeration Date | 2014-07-16 |
| Last Update Date | 2019-09-19 |