| NPI | 1245518406 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: WI 57246) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: WY 8744a) |
| Enumeration Date | 2011-07-21 |
| Last Update Date | 2021-01-14 |