| NPI | 1619967452 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: FL 125960) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: GA 42979) |
| Enumeration Date | 2005-10-24 |
| Last Update Date | 2018-07-18 |