| NPI | 1275979346 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: ID M-15202) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: FL 18456) |
| Enumeration Date | 2013-05-16 |
| Last Update Date | 2020-08-10 |