| NPI | 1730297698 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: SC 21772) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: GA 63540) |
| Enumeration Date | 2006-08-29 |
| Last Update Date | 2020-10-20 |