| NPI | 1982081089 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: OR DO187169) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: MT 67882) |
| Enumeration Date | 2015-04-28 |
| Last Update Date | 2018-11-21 |