| NPI | 1225488414 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: IA DO-05090) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: IA R-10662) |
| Enumeration Date | 2016-06-17 |
| Last Update Date | 2019-07-05 |