| NPI | 1679709539 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: GA 067979) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: SC 81672) |
| 207Q00000X Family Medicine (Licence: NC 2018-02700) | |
| 207Q00000X Family Medicine (Licence: CA C159178) | |
| 207Q00000X Family Medicine (Licence: VA 0101265867) | |
| Enumeration Date | 2009-06-05 |
| Last Update Date | 2019-09-13 |