| NPI | 1164400214 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: SC 8959) |
| Additional Taxonomies | 207QA0505X Family Medicine, Adult Medicine (Licence: SC 8959) |
| Enumeration Date | 2006-01-07 |
| Last Update Date | 2020-12-31 |