| NPI | 1972093979 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: ID M-15008) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: ID MRM-1722) |
| Enumeration Date | 2018-05-15 |
| Last Update Date | 2021-09-22 |