| NPI | 1780971655 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: IA DO-05193) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: NE 6659) |
| Enumeration Date | 2011-06-29 |
| Last Update Date | 2022-07-05 |