| NPI | 1760898795 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: IA DO-04817) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: IA R-10127) |
| Enumeration Date | 2014-07-10 |
| Last Update Date | 2024-01-02 |