| NPI | 1154522951 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: NC 2014-02221) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: VA 0116018200) |
| Enumeration Date | 2007-05-30 |
| Last Update Date | 2020-08-19 |