| NPI | 1356331888 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: WI 53699) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: IA 19903) |
| Enumeration Date | 2005-10-26 |
| Last Update Date | 2021-02-19 |