| NPI | 1467430181 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: IA 24265) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: WI 28154) |
| Enumeration Date | 2006-01-03 |
| Last Update Date | 2018-08-07 |