| NPI | 1679589055 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: NC 99-00752) |
| Additional Taxonomies | 208D00000X General Practice (Licence: NC 99-00752) |
| Enumeration Date | 2006-07-31 |
| Last Update Date | 2019-08-07 |