| NPI | 1538422308 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: MD H0093323) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: HI DOS1559) |
| Enumeration Date | 2012-06-18 |
| Last Update Date | 2022-05-20 |