| NPI | 1205035342 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: SC 29768) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: SC LL29768) |
| Enumeration Date | 2007-07-17 |
| Last Update Date | 2020-10-21 |