| NPI | 1609884386 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: IA MD-19353) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: IA 19353) |
| Enumeration Date | 2006-08-04 |
| Last Update Date | 2014-10-02 |