| NPI | 1982960324 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: IA DO-05409) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: WI 61731) |
| Enumeration Date | 2012-04-10 |
| Last Update Date | 2019-08-08 |