| NPI | 1942287917 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: IA DO-02435) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: IA 02435) |
| Enumeration Date | 2005-12-29 |
| Last Update Date | 2021-09-14 |