| NPI | 1770795049 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: NM A-1784-13) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: AZ 4554) |
| Enumeration Date | 2007-05-07 |
| Last Update Date | 2018-03-17 |