| NPI | 1659372811 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: MD H43617) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: NC 200000992) |
| Enumeration Date | 2005-08-09 |
| Last Update Date | 2021-10-01 |