| NPI | 1790817336 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: LA 308106) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: NM 87158) |
| Enumeration Date | 2007-03-09 |
| Last Update Date | 2018-03-15 |