| NPI | 1538303060 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: SC 32974) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: WI 56656-20) |
| Enumeration Date | 2009-04-28 |
| Last Update Date | 2020-04-17 |