| NPI | 1609847615 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: ID M5570) |
| Additional Taxonomies | 174400000X Specialist (Licence: ID M5570) |
| Enumeration Date | 2006-01-28 |
| Last Update Date | 2020-10-22 |