| NPI | 1881622801 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: NC 200201056) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: WI 33365) |
| Enumeration Date | 2006-06-29 |
| Last Update Date | 2020-07-24 |