| NPI | 1730594474 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: OR MD207391) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: AZ 52101) |
| Enumeration Date | 2014-06-20 |
| Last Update Date | 2022-04-13 |