| NPI | 1962418640 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: IA 31812) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: NE 30531) |
| Enumeration Date | 2006-08-01 |
| Last Update Date | 2019-10-15 |