| NPI | 1144310624 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: NC 2018-02766) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: MS 14467) |
| Enumeration Date | 2006-10-13 |
| Last Update Date | 2019-02-27 |