| NPI | 1144600255 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: SC 86930) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: NC 2016-01831) |
| Enumeration Date | 2015-06-03 |
| Last Update Date | 2022-02-02 |