| NPI | 1275735045 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: ID O-0838) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: AZ 5012) |
| Enumeration Date | 2007-06-04 |
| Last Update Date | 2021-11-16 |