| NPI | 1700858255 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: LA 202160) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: AL 00024312) |
| Enumeration Date | 2006-02-07 |
| Last Update Date | 2018-12-13 |