| NPI | 1447376983 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: AZ 44118) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: WY 7822A) |
| Enumeration Date | 2007-03-22 |
| Last Update Date | 2020-07-06 |