| NPI | 1801183124 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: NC 2014-00976) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: MS T2509) |
| Enumeration Date | 2011-07-07 |
| Last Update Date | 2016-06-09 |