| NPI | 1558463471 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: NC 29146) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: GA 025373) |
| Enumeration Date | 2006-09-01 |
| Last Update Date | 2020-02-07 |