| NPI | 1922369123 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: SC 52700) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: VA 0101255469) |
| Enumeration Date | 2012-06-04 |
| Last Update Date | 2021-09-10 |