| NPI | 1285775296 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: NC 2013-02108) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: SC 36327) |
| Enumeration Date | 2007-02-11 |
| Last Update Date | 2019-02-12 |