| NPI | 1235572298 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: SC 40062) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: NC 2018-02335) |
| Enumeration Date | 2013-04-09 |
| Last Update Date | 2021-07-09 |