| NPI | 1417112442 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: AR E-15729) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: WI 56165) |
| Enumeration Date | 2008-07-18 |
| Last Update Date | 2022-10-21 |