| NPI | 1740530302 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: ID M-14093) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: OR MD187049) |
| Enumeration Date | 2012-09-11 |
| Last Update Date | 2019-04-12 |