| NPI | 1659539427 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: IA MD-42279) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: KS 6965) |
| Enumeration Date | 2008-05-29 |
| Last Update Date | 2020-07-08 |