| NPI | 1093155988 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: UT 6210629-1204) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: ID MRO-1325) |
| Enumeration Date | 2013-06-25 |
| Last Update Date | 2021-08-02 |