| NPI | 1639307192 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: IA 04620) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: KS 7182) |
| Enumeration Date | 2009-06-23 |
| Last Update Date | 2020-11-19 |