| NPI | 1457368185 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: NC 2010-01894) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: GA 049190) |
| Enumeration Date | 2006-08-02 |
| Last Update Date | 2021-03-09 |