| NPI | 1356397103 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: LA 017233) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: LA MD.017233) |
| Enumeration Date | 2006-05-25 |
| Last Update Date | 2020-01-22 |