| NPI | 1346535390 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: MS 22826) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: LA 311654) |
| Enumeration Date | 2011-06-17 |
| Last Update Date | 2021-01-26 |