| NPI | 1821180134 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: ID M-9877) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: UT 51391207205) |
| Enumeration Date | 2006-09-28 |
| Last Update Date | 2020-10-02 |