| NPI | 1164718813 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: MT 33875) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: ID MR-1179) |
| Enumeration Date | 2011-06-21 |
| Last Update Date | 2021-03-24 |