| NPI | 1902245798 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207QA0505X Family Medicine Adult Medicine (Licence: MD D84866) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: VA 0101260573) |
| 207Q00000X Family Medicine (Licence: SC 35649) | |
| 207Q00000X Family Medicine (Licence: DC MD045909) | |
| 207Q00000X Family Medicine (Licence: MD D84866) | |
| Enumeration Date | 2013-06-14 |
| Last Update Date | 2022-01-19 |