| NPI | 1548571987 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: MT 88785) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: NC 165698) |
| Enumeration Date | 2010-06-30 |
| Last Update Date | 2021-04-28 |