| NPI | 1891082640 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: SC 33574) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: SC LL33574) |
| Enumeration Date | 2011-06-30 |
| Last Update Date | 2020-11-11 |