| NPI | 1336352012 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: NC 95-01448) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: SC 39542) |
| Enumeration Date | 2007-05-08 |
| Last Update Date | 2019-04-08 |