| NPI | 1255760260 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: IA MD-43498) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: IA R-9658) |
| Enumeration Date | 2013-11-11 |
| Last Update Date | 2021-04-28 |