| NPI | 1609229657 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: IA MD-47597) |
| Additional Taxonomies | 363L00000X Nurse Practitioner (Licence: IA A133582) |
| 207Q00000X Family Medicine (Licence: IA R11108) | |
| Enumeration Date | 2016-07-14 |
| Last Update Date | 2021-05-26 |