| NPI | 1568789980 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: ID M-15675) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: MI 4301106809) |
| 207Q00000X Family Medicine (Licence: GA 63989) | |
| Enumeration Date | 2010-04-24 |
| Last Update Date | 2021-04-12 |