| NPI | 1518943141 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207QA0505X Family Medicine, Adult Medicine (Licence: IA 02857) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: IA 02857) |
| Enumeration Date | 2005-12-15 |
| Last Update Date | 2019-01-08 |