| NPI | 1043207939 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: IA DO-04161) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: NE 5262) |
| Enumeration Date | 2005-10-05 |
| Last Update Date | 2020-08-28 |