| NPI | 1184192510 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: AR E-13916) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: MO 2018036941) |
| Enumeration Date | 2018-11-03 |
| Last Update Date | 2022-05-17 |