| NPI | 1861464109 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: CT 034672) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: CT 064672) |
| Enumeration Date | 2006-02-02 |
| Last Update Date | 2021-06-15 |