| NPI | 1902972995 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: GA 080956) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: HI MD 10442) |
| Enumeration Date | 2006-11-28 |
| Last Update Date | 2018-07-17 |