| NPI | 1336157916 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: MT 987209) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: OR MD21190) |
| Enumeration Date | 2006-08-03 |
| Last Update Date | 2021-04-21 |