| NPI | 1255710331 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: NC 2018-00120) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: SC LL38133) |
| Enumeration Date | 2015-05-22 |
| Last Update Date | 2018-07-03 |