| NPI | 1740620368 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: IA 04838) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: IA R-9695) |
| Enumeration Date | 2013-06-27 |
| Last Update Date | 2022-03-01 |