| NPI | 1225324361 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: ID M-16455) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: IL 036.138833) |
| 207Q00000X Family Medicine (Licence: CO DR.0058728) | |
| 207Q00000X Family Medicine (Licence: IA MD-41559) | |
| Enumeration Date | 2011-06-28 |
| Last Update Date | 2022-08-15 |