| NPI | 1013358019 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: IA 04570) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: IA R9806) |
| Enumeration Date | 2013-07-08 |
| Last Update Date | 2020-07-08 |