| NPI | 1730121740 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: ID M8223) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: MT 63004) |
| Enumeration Date | 2006-06-12 |
| Last Update Date | 2018-03-20 |