| NPI | 1982016788 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: ID M13796) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: UT 9495056-1205) |
| Enumeration Date | 2014-05-28 |
| Last Update Date | 2020-11-16 |