| NPI | 1669489175 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: AZ 34381) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: MD D57102) |
| Enumeration Date | 2006-08-01 |
| Last Update Date | 2018-12-30 |