| NPI | 1104266956 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: AZ 61339) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: OR MD177853) |
| Enumeration Date | 2013-06-26 |
| Last Update Date | 2020-11-16 |