| NPI | 1972918894 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: IA DO-04750) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: IA R-10100) |
| Enumeration Date | 2014-06-30 |
| Last Update Date | 2020-12-14 |