| NPI | 1861634008 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: IA 4148) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: NE 756) |
| Enumeration Date | 2009-04-02 |
| Last Update Date | 2020-10-08 |