| NPI | 1558504316 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: NC 2019-01716) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: SC 01611) |
| Enumeration Date | 2009-04-09 |
| Last Update Date | 2019-09-04 |