| NPI | 1013355544 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: SC 37129) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: SC LL37129) |
| 207Q00000X Family Medicine (Licence: NC 192239) | |
| Enumeration Date | 2013-06-06 |
| Last Update Date | 2020-10-14 |