| NPI | 1366732604 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: NM MD2017-0882) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: NE 26460) |
| 207Q00000X Family Medicine (Licence: SD 8607) | |
| 207Q00000X Family Medicine (Licence: PA MD443240) | |
| Enumeration Date | 2011-04-07 |
| Last Update Date | 2018-03-17 |