| NPI | 1821480666 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: AZ 006453) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: MO 2014033463) |
| 207Q00000X Family Medicine (Licence: NY 275096) | |
| Enumeration Date | 2015-03-03 |
| Last Update Date | 2018-03-17 |