| NPI | 1538117072 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: NC 9900213) |
| Additional Taxonomies | 208D00000X General Practice (Licence: NC 9900213) |
| Enumeration Date | 2006-05-05 |
| Last Update Date | 2018-04-16 |