| NPI | 1568575041 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: GA 072097) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: NC 200401669) |
| Enumeration Date | 2006-08-17 |
| Last Update Date | 2018-06-26 |