| NPI | 1295795920 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: SC 0584) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: NC 204061) |
| Enumeration Date | 2006-03-25 |
| Last Update Date | 2020-04-17 |