| NPI | 1225444714 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: NM MD2017-0814) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: NM RS2014-0581) |
| Enumeration Date | 2014-07-07 |
| Last Update Date | 2022-09-06 |