| NPI | 1700224524 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: HI DOS-1737) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: SC 35694) |
| Enumeration Date | 2013-06-14 |
| Last Update Date | 2021-06-02 |