| NPI | 1316965908 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: AL 25048) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: AL 00025048) |
| Enumeration Date | 2006-07-18 |
| Last Update Date | 2020-10-01 |