| NPI | 1609857614 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: TN 0000003650) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: FL OS 0005959) |
| Enumeration Date | 2005-11-07 |
| Last Update Date | 2020-02-24 |