| NPI | 1902865447 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: SC 83446) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: NC 30320) |
| Enumeration Date | 2006-03-22 |
| Last Update Date | 2021-01-28 |