| NPI | 1659571347 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: SC 29967) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: SC LL29967) |
| Enumeration Date | 2007-07-20 |
| Last Update Date | 2021-04-27 |