| NPI | 1972892339 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: AZ 53748) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: WI 59910) |
| Enumeration Date | 2011-04-06 |
| Last Update Date | 2021-10-12 |