| NPI | 1851773279 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: NM MD2019-0096) |
| Additional Taxonomies | 208D00000X General Practice (Licence: PR 31,700-R) |
| Enumeration Date | 2015-06-22 |
| Last Update Date | 2019-07-02 |