| NPI | 1306895669 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: FL ME80806) |
| Additional Taxonomies | 207QA0505X Family Medicine, Adult Medicine (Licence: FL me0080806) |
| Enumeration Date | 2006-05-06 |
| Last Update Date | 2021-07-30 |