| NPI | 1336563063 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: ID OC-0126) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: NE 1353) |
| Enumeration Date | 2014-02-17 |
| Last Update Date | 2021-06-01 |