| NPI | 1851708481 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: IA MD-43694) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: IA R10162) |
| Enumeration Date | 2014-07-15 |
| Last Update Date | 2018-03-17 |