| NPI | 1578875696 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: OR MD161834) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: HI MDR-5905) |
| Enumeration Date | 2010-07-06 |
| Last Update Date | 2015-08-12 |