| NPI | 1205887254 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: NC 2019-00351) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: NE 20279) |
| Enumeration Date | 2006-05-15 |
| Last Update Date | 2019-07-31 |