| NPI | 1174742985 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: IA 39113) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: KS 04-32731) |
| Enumeration Date | 2007-04-24 |
| Last Update Date | 2020-09-10 |