| NPI | 1326451246 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: MS 25039) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: SC LL37051) |
| Enumeration Date | 2014-06-09 |
| Last Update Date | 2019-10-21 |