| NPI | 1396265237 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: NC 2020-02334) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: VA 0116030882) |
| Enumeration Date | 2017-06-21 |
| Last Update Date | 2020-11-16 |