| NPI | 1184684151 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: NC 2008-00321) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: VA 0101047815) |
| Enumeration Date | 2006-03-24 |
| Last Update Date | 2020-10-25 |