| NPI | 1659479764 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: FL OS7404) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: PA OS003774L) |
| Enumeration Date | 2006-09-20 |
| Last Update Date | 2020-08-27 |