| NPI | 1578875746 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: IA MD-42014) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: IA r8978) |
| Enumeration Date | 2010-07-05 |
| Last Update Date | 2024-01-18 |