| NPI | 1588892814 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: SC 37101) |
| Additional Taxonomies | 208D00000X General Practice (Licence: VA 0101250468) |
| Enumeration Date | 2009-06-25 |
| Last Update Date | 2021-06-24 |