| NPI | 1689603219 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: ID M-11783) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: VA 0101049734) |
| Enumeration Date | 2006-07-03 |
| Last Update Date | 2019-06-20 |