| NPI | 1013326834 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: NC 201902308) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: VA 0102204344) |
| 207Q00000X Family Medicine (Licence: VA 0116027612) | |
| Enumeration Date | 2014-08-06 |
| Last Update Date | 2020-07-08 |