| NPI | 1013180132 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: AL 29111) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: AL L.2921) |
| Enumeration Date | 2008-04-09 |
| Last Update Date | 2021-08-03 |