| NPI | 1083820120 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: NM MD 2012-0859) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: MA 239066) |
| Enumeration Date | 2007-05-15 |
| Last Update Date | 2023-01-06 |