| NPI | 1124049978 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: NC 9300722) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: SC 10912) |
| Enumeration Date | 2006-07-21 |
| Last Update Date | 2021-02-11 |