| NPI | 1902850779 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: SD 5642) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: WY 11278A) |
| Enumeration Date | 2006-05-19 |
| Last Update Date | 2021-05-17 |