| NPI | 1710184155 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: HI MD15188) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: HI MDR5040) |
| Enumeration Date | 2007-06-29 |
| Last Update Date | 2020-06-25 |