| NPI | 1275694242 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: MI 4301077232) |
| Additional Taxonomies | 208D00000X General Practice (Licence: PR 9465) |
| Enumeration Date | 2006-12-13 |
| Last Update Date | 2020-12-15 |