| NPI | 1912192220 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: NC 2009-01381) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: VA 0101249246) |
| Enumeration Date | 2007-09-10 |
| Last Update Date | 2020-11-25 |