| NPI | 1336179142 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: NC 201501465) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: VA 0101251587) |
| Enumeration Date | 2006-07-04 |
| Last Update Date | 2020-10-28 |