| NPI | 1700444932 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: IA DO-05707) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: IA R-11616) |
| Enumeration Date | 2019-06-03 |
| Last Update Date | 2023-01-16 |