| NPI | 1558700468 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: NC 2016-01632) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: GA RTP006577) |
| Enumeration Date | 2013-06-25 |
| Last Update Date | 2018-03-17 |