| NPI | 1912903311 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: HI MD22584) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: MT 20695) |
| Enumeration Date | 2005-06-22 |
| Last Update Date | 2023-05-31 |