| NPI | 1700980281 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: AK 6945) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: NC 36085) |
| Enumeration Date | 2006-09-12 |
| Last Update Date | 2020-03-30 |