| NPI | 1346359494 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: OR MD12128) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: ID M5297) |
| Enumeration Date | 2006-08-30 |
| Last Update Date | 2021-04-14 |