| NPI | 1255390795 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: NC 35292) |
| Additional Taxonomies | 208D00000X General Practice (Licence: NC 35292) |
| Enumeration Date | 2006-03-22 |
| Last Update Date | 2020-01-06 |