| NPI | 1144603408 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: NM MD2018-0153) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: NM RS2015-0486) |
| Enumeration Date | 2015-07-06 |
| Last Update Date | 2018-07-11 |