| NPI | 1598857187 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: NC 2014-01893) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: GA 044938) |
| Enumeration Date | 2006-09-29 |
| Last Update Date | 2020-10-25 |