| NPI | 1336431055 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: IA 41135) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: NE 26804) |
| Enumeration Date | 2011-05-12 |
| Last Update Date | 2022-03-25 |