| NPI | 1649610528 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: ID M-12650) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: ID MRM-1329) |
| Enumeration Date | 2013-06-25 |
| Last Update Date | 2023-05-09 |