| NPI | 1558335042 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: HI MD-20577) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: NV 9932) |
| Enumeration Date | 2006-02-14 |
| Last Update Date | 2020-08-04 |