| NPI | 1588089783 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: NC 2017-01772) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: SC 36687) |
| Enumeration Date | 2014-02-25 |
| Last Update Date | 2019-02-12 |