| NPI | 1881044089 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: IA MD46785) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: IA R-10665) |
| Enumeration Date | 2016-06-18 |
| Last Update Date | 2020-03-31 |