| NPI | 1376541581 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: NC 2018-02625) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: VA 0101840596) |
| Enumeration Date | 2005-07-12 |
| Last Update Date | 2018-11-28 |