| NPI | 1801096599 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: IA MD-37603) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: SD 7592) |
| Enumeration Date | 2007-07-20 |
| Last Update Date | 2016-06-24 |