| NPI | 1912435405 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: AZ 61279) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: AZ R76359) |
| Enumeration Date | 2017-05-26 |
| Last Update Date | 2020-06-19 |