| NPI | 1336123199 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: AZ 30360) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: SC 23937) |
| Enumeration Date | 2005-12-05 |
| Last Update Date | 2018-12-31 |