| NPI | 1831321579 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: IA DO-04117) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: IA 4117) |
| 207Q00000X Family Medicine (Licence: IA R-8736) | |
| Enumeration Date | 2009-08-13 |
| Last Update Date | 2021-10-03 |