| NPI | 1700306974 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: IA DO05279) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: IA R-10920) |
| Enumeration Date | 2017-06-20 |
| Last Update Date | 2020-10-26 |