| NPI | 1083650071 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: IA MD-38106) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: IA R7782) |
| Enumeration Date | 2006-06-20 |
| Last Update Date | 2021-02-01 |