| NPI | 1902847916 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: NC 25094) |
| Additional Taxonomies | 207L00000X Anesthesiology (Licence: NC 25094) |
| 207Q00000X Family Medicine (Licence: SC 17497) | |
| Enumeration Date | 2006-06-09 |
| Last Update Date | 2019-11-04 |