| NPI | 1619535093 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: IA DO-05637) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: IA R-11610) |
| Enumeration Date | 2019-05-31 |
| Last Update Date | 2021-01-07 |