| NPI | 1699118356 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: IA DO-04846) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: IA R-9616) |
| Enumeration Date | 2013-04-12 |
| Last Update Date | 2023-03-07 |