| NPI | 1679779052 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: NM MD2010-0710) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: NM RS20070331) |
| Enumeration Date | 2007-06-22 |
| Last Update Date | 2024-07-02 |