| NPI | 1659484509 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: ID M-10963) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: DE C1-0007593) |
| Enumeration Date | 2006-08-16 |
| Last Update Date | 2020-11-25 |