| NPI | 1912985151 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: SC 33965) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: VA 0101236885) |
| Enumeration Date | 2006-01-06 |
| Last Update Date | 2020-10-20 |