| NPI | 1487005740 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: NM MD2019-0873) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: NM RS2016-0518) |
| Enumeration Date | 2016-06-28 |
| Last Update Date | 2022-08-12 |