| NPI | 1538555461 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: NM MD2019-1096) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: NM RS2015-0330) |
| 208D00000X General Practice (Licence: NM MD2019-1096) | |
| Enumeration Date | 2015-04-07 |
| Last Update Date | 2020-08-11 |