| NPI | 1215596937 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: AZ 67232) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: NM MD2022-1994) |
| 207Q00000X Family Medicine (Licence: NM RS2019-0439) | |
| Enumeration Date | 2019-06-06 |
| Last Update Date | 2024-09-23 |