| NPI | 1194847186 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: MA 288087) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: AK 6718) |
| Enumeration Date | 2007-04-03 |
| Last Update Date | 2021-10-05 |