| NPI | 1730671470 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: IA DO-05451) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: IA R-11235) |
| Enumeration Date | 2018-05-30 |
| Last Update Date | 2021-12-20 |