| NPI | 1396796504 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: NV 17270) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: HI MD-13784) |
| Enumeration Date | 2006-05-12 |
| Last Update Date | 2024-06-18 |