| NPI | 1932124393 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: OR MD26238) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: WI 50437) |
| Enumeration Date | 2006-07-13 |
| Last Update Date | 2021-03-15 |