| NPI | 1811004385 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: WI 35998-20) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: WI 35998) |
| Enumeration Date | 2006-08-23 |
| Last Update Date | 2020-10-07 |