| NPI | 1164836235 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: AZ R74610) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: UT 12300962-1205) |
| Enumeration Date | 2014-06-17 |
| Last Update Date | 2022-03-18 |