| NPI | 1770895070 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: MO 2013026514) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: IA R-8840) |
| Enumeration Date | 2010-07-02 |
| Last Update Date | 2020-11-11 |