| NPI | 1215457189 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: NE 32) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: IA R-11041) |
| Enumeration Date | 2017-06-22 |
| Last Update Date | 2020-08-18 |