| NPI | 1265482905 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: ID O-1077) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: ID O-0380) |
| Enumeration Date | 2006-05-11 |
| Last Update Date | 2021-09-29 |