| NPI | 1659729986 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: OR DO192878) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: OR PG177167) |
| Enumeration Date | 2016-05-26 |
| Last Update Date | 2020-11-03 |