| NPI | 1366612566 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: SC 37906) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: GA 61821) |
| Enumeration Date | 2008-03-04 |
| Last Update Date | 2020-05-18 |