| NPI | 1952831521 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: IA DO-05265) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: IA R-10969) |
| Enumeration Date | 2017-06-15 |
| Last Update Date | 2024-01-11 |