| NPI | 1134307911 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: WY 11838A) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: GA 056477) |
| Enumeration Date | 2008-02-05 |
| Last Update Date | 2021-02-18 |