| NPI | 1871900191 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: ND 14524) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: IA R-10152) |
| Enumeration Date | 2014-07-18 |
| Last Update Date | 2018-01-22 |