| NPI | 1114365905 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: NC 2020-03839) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: MO 2013017420) |
| Enumeration Date | 2013-06-13 |
| Last Update Date | 2021-02-12 |