| NPI | 1316999865 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: IA 37407) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: WI 44886020) |
| Enumeration Date | 2006-05-16 |
| Last Update Date | 2020-11-13 |