| NPI | 1639185739 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: NM MD2018-0258) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: AZ 17404) |
| Enumeration Date | 2006-07-31 |
| Last Update Date | 2018-08-24 |