| NPI | 1922443191 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: OR MD0207460) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: MD D0083860) |
| Enumeration Date | 2013-05-01 |
| Last Update Date | 2021-10-14 |