| NPI | 1417983610 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: AZ 43006) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: VA 0101246495) |
| Enumeration Date | 2006-06-23 |
| Last Update Date | 2020-05-11 |