| NPI | 1124467014 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: SC 39069) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: NC 191254) |
| Enumeration Date | 2013-06-24 |
| Last Update Date | 2019-01-10 |