| NPI | 1205339090 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: AZ 63377) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: UT 6367878-1205) |
| Enumeration Date | 2018-03-17 |
| Last Update Date | 2021-08-09 |