| NPI | 1558616300 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: NM MD2018-0201) |
| Additional Taxonomies | 207QA0505X Family Medicine, Adult Medicine (Licence: NH 17060) |
| Enumeration Date | 2012-07-18 |
| Last Update Date | 2018-08-29 |