| NPI | 1386653707 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: IA DO-03018) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: IA 03018) |
| Enumeration Date | 2006-08-05 |
| Last Update Date | 2021-02-04 |