| NPI | 1922078823 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: SC 13422) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: NC 32357) |
| Enumeration Date | 2006-01-24 |
| Last Update Date | 2017-12-28 |