| NPI | 1780117549 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: AZ 62094) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: NC 2018-02102) |
| Enumeration Date | 2017-04-09 |
| Last Update Date | 2020-10-09 |