| NPI | 1720047137 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: FL ME60766) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: KY 28306) |
| Enumeration Date | 2006-03-23 |
| Last Update Date | 2018-12-31 |