| NPI | 1174855159 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: AZ 005379) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: UT 9167838-8904) |
| Enumeration Date | 2010-02-02 |
| Last Update Date | 2019-11-25 |