| NPI | 1316914872 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: AZ 34072) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: LA 025541) |
| Enumeration Date | 2006-03-03 |
| Last Update Date | 2020-08-24 |