| NPI | 1174964225 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: NC 2020-00355) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: IA DO-04671) |
| Enumeration Date | 2013-07-17 |
| Last Update Date | 2020-10-26 |