| NPI | 1225448327 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: AZ R74402) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: ID M-16769) |
| Enumeration Date | 2014-04-29 |
| Last Update Date | 2022-09-22 |