| NPI | 1659325694 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: IA 28869) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: WI 31856) |
| Enumeration Date | 2006-05-22 |
| Last Update Date | 2021-04-06 |