| NPI | 1275829376 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: ID M-15982) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: IA MD-42445) |
| 207Q00000X Family Medicine (Licence: SC LL33736) | |
| 207Q00000X Family Medicine (Licence: NC 2014-01351) | |
| Enumeration Date | 2011-06-27 |
| Last Update Date | 2021-09-30 |