| NPI | 1053497123 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: FL ME101538) |
| Additional Taxonomies | 207QA0505X Family Medicine, Adult Medicine (Licence: FL 507129) |
| Enumeration Date | 2006-10-31 |
| Last Update Date | 2020-08-24 |