| NPI | 1619948379 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: SC 17420) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: NC 9601513) |
| Enumeration Date | 2006-01-31 |
| Last Update Date | 2021-01-13 |