| NPI | 1982098604 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: AZ 009351) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: NC 208394) |
| Enumeration Date | 2015-03-19 |
| Last Update Date | 2022-04-18 |