| NPI | 1457672289 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: SC 32853) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: SC LL32853) |
| Enumeration Date | 2010-06-16 |
| Last Update Date | 2020-12-08 |