| NPI | 1518378116 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: MS 24932) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: GA 077114) |
| Enumeration Date | 2014-05-16 |
| Last Update Date | 2020-07-09 |