| NPI | 1932557782 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: ID M-14005) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: ID MRM-1580) |
| Enumeration Date | 2016-06-01 |
| Last Update Date | 2020-09-17 |