| NPI | 1477896629 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: HI DOS-1747) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: UT 9096182-1204) |
| Enumeration Date | 2013-04-05 |
| Last Update Date | 2021-07-09 |