| NPI | 1790792380 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: NC 2020-04208) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: NE 19664) |
| Enumeration Date | 2006-08-03 |
| Last Update Date | 2020-11-25 |