| NPI | 1558364265 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: FL ME69470) |
| Additional Taxonomies | 174400000X Specialist (Licence: FL me69470) |
| Enumeration Date | 2005-05-27 |
| Last Update Date | 2021-04-12 |