| NPI | 1992097612 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: UT 317131-1204) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: MI 5101018972) |
| Enumeration Date | 2011-05-12 |
| Last Update Date | 2021-08-30 |