| NPI | 1407197684 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207QA0505X Family Medicine, Adult Medicine (Licence: MO 2020012799) |
| Additional Taxonomies | 207QA0505X Family Medicine, Adult Medicine (Licence: AR C-8117) |
| Enumeration Date | 2013-03-12 |
| Last Update Date | 2020-09-30 |