| NPI | 1457842940 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: OR MD204114) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: ID MRM-1741) |
| Enumeration Date | 2018-05-21 |
| Last Update Date | 2022-02-01 |