| NPI | 1972503332 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: SC 1304) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: NC 200600315) |
| Enumeration Date | 2005-07-28 |
| Last Update Date | 2021-06-30 |