| NPI | 1598898363 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: NM MD2019-0734) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: UT 356087-1205) |
| 207Q00000X Family Medicine (Licence: MA 79259) | |
| Enumeration Date | 2007-03-13 |
| Last Update Date | 2019-10-03 |