| NPI | 1154437317 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: AZ 51526) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: WY 6371A) |
| Enumeration Date | 2006-08-21 |
| Last Update Date | 2021-01-26 |