| NPI | 1740307479 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: ID O-0501) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: ME 1918) |
| Enumeration Date | 2007-03-26 |
| Last Update Date | 2020-08-03 |