| NPI | 1265658264 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: SC 31057) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: ND 10713) |
| Enumeration Date | 2007-04-18 |
| Last Update Date | 2020-10-21 |