| NPI | 1154989291 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: IA MD-47948) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: IA R-11606) |
| Enumeration Date | 2019-06-04 |
| Last Update Date | 2022-07-14 |