| NPI | 1225558562 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: IA MD-47471) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: NM RS2017-0573) |
| Enumeration Date | 2017-06-27 |
| Last Update Date | 2020-09-29 |