| NPI | 1588194831 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: IA DO05303) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: IA R-11026) |
| Enumeration Date | 2017-06-19 |
| Last Update Date | 2024-05-31 |