| NPI | 1891850434 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: NM A-2482-21) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: AZ 4583) |
| Enumeration Date | 2006-12-26 |
| Last Update Date | 2021-05-12 |