| NPI | 1346352317 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: AL 15144) |
| Additional Taxonomies | 174400000X Specialist (Licence: AL 15144) |
| Enumeration Date | 2006-08-31 |
| Last Update Date | 2021-01-07 |