| NPI | 1649275587 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: ID O-292) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: ID O292) |
| Enumeration Date | 2005-06-16 |
| Last Update Date | 2016-11-15 |