| NPI | 1295268258 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: MD H0096517) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: NM A-2336-20) |
| 207Q00000X Family Medicine (Licence: MA 283140) | |
| 207Q00000X Family Medicine (Licence: MI 5101026558) | |
| Enumeration Date | 2017-04-06 |
| Last Update Date | 2024-04-30 |