| NPI | 1376926543 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: WI 70329) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: IA R10260) |
| Enumeration Date | 2015-07-06 |
| Last Update Date | 2020-12-31 |