| NPI | 1396793550 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: SC 37338) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: FL me81725) |
| Enumeration Date | 2006-05-04 |
| Last Update Date | 2021-10-27 |