| NPI | 1821250721 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: FL OS 12806) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: VA 0102203242) |
| Enumeration Date | 2008-07-01 |
| Last Update Date | 2021-12-02 |