| NPI | 1316948425 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: WA MD60096330) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: IN 01055440A) |
| Enumeration Date | 2005-08-10 |
| Last Update Date | 2021-05-10 |